more
blood tests
After
the initial blood test shows a compatible blood type, the potential
donor will undergo more extensive blood tests.
These blood
tests include:
Preliminary
white cell crossmatch - a blood test between the donor's white blood
cells and the serum of the recipient. The serum contains antibodies
that can react with codes on the donor cells. If these are present,
the transplant cannot be performed since the antibodies will immediately
react against the donor's kidney cells and consequently cause immediate
loss of the transplant.
Tissue typing of the donor cells. This checks the tissue match between six codes on the donor and recipient cells. This is the classical tissue match. While still required as part of the transplant process, tissue type matching is rarely a consideration for living organ donation now.
Blood tests to assess factors including white blood cell count, liver function, diabetes and infectious diseases such as HIV and hepatitis status.
and
then a few more tests
If the blood tests confirm a match, then the following are required:
complete medical history, physical exam, psychological
assessment, and a chest
x-ray. A
kidney function test which includes two 24-hour urine collections to
check the donor's creatinine clearance.
For all female donors, a complete gynecological examination is required. For females 32 years and older, a mammogram is also required. In general, the transplant nurse coordinator, in conjunction with your physician, can arrange testing.
then
finally, the last few tests
After
both the recipient and donor have completed all their pre-transplant
tests, the donor will be discussed at the transplant program's Medical
Review Board meeting. The surgeons, nephrologists, nurse coordinators
and social workers will review the medical, financial and psychosocial
aspects of the donor during this meeting. If approved, the transplant
will be scheduled for a date convenient to the donor, recipient and
transplant team. At
this point in the process there are two remaining pre-transplant requirements
for the donor: evaluation of the kidney blood vessels for kidney donors
and a final crossmatch.
checking
the blood vessels of donor kidneys
There are two methods for studying the blood vessels. One way is the
renal arteriogram, which is performed by injecting dye through a small
tube in the donor's groin artery. The kidney blood vessels are studied
to reveal the anatomy of the kidneys and rule out any unsuspected disease
or abnormalities. It is also used to identify which of the two kidneys
would be more suitable for the transplant.
The renal arteriogram usually takes place at the medical center, but does not require an overnight stay. This is the only invasive test the prospective donor must undergo and is only given to those already approved for organ donation. Before being allowed to go home, the donor must lie flat for five hours following the arteriogram. The renal arteriogram is typically performed at least four days prior to the transplant. In some circumstances, the test may be performed at a certified facility near the donor's home.
The other way of studying the kidney blood vessels is by a C.T. Angiography. This is a highly sophisticated x-ray. It also takes place at the medical center and does not require an overnight stay. A specialized dye is injected through a small arm vein. Then a CT scan is taken of the kidneys.
The decision as to which test is done is made by the transplant surgeons and their choice will be discussed with you.
the
final blood test
The last test that needs to be completed is another crossmatch. It is
the final comparison of the donor's blood cells and recipient's blood
serum to make sure that the recipient has not created any antibodies
that would attack the donated kidney. This test is performed within
1 week of surgery, typically within 48 hours
